Presentation on theme: "Collaboration with Medi-Cal Managed Care Plans CPSP Annual Meeting November 7, 2012 Candice Gray, MPH, CHES Program Standards Branch Maternal, Child and."— Presentation transcript:
Collaboration with Medi-Cal Managed Care Plans CPSP Annual Meeting November 7, 2012 Candice Gray, MPH, CHES Program Standards Branch Maternal, Child and Adolescent Health Division
Medi-Cal Managed Care and MCAH State MCAH and Medi-Cal Managed Care (MCMC) collaboration MCMC State Boilerplate Contracts –http://www.dhcs.ca.gov/provgovpart/Pages/M MCDBoilerplateContracts.aspxhttp://www.dhcs.ca.gov/provgovpart/Pages/M MCDBoilerplateContracts.aspx MCMC Policy Letter issued to Health Plans Feb, 28, 2012 –Letter outlines the perinatal services that are required to be provided by all plans. Local Managed Care Plan Contact List
Perinatal System of Care MCAH oversees the perinatal system of care in California PSCs, under the direction of the MCAH Director, oversee perinatal services in each LHJ, including CPSP MCMC plans are located in 33 LHJs –Plans are responsible to oversee their providers and services provided to the MCAH population –Local MCAH have the authority to work with plans to ensure the quality of those services.
Medi-Cal Managed Care LHJs Expansion planned to 28 rural counties beginning June 1, 2013. By 2014, 90% of patients will be in managed care plans. MCMC is in 33 LHJs (30 counties)
MCMC Contracted Scope of Services MCMC plans are required, by contract, to provide a variety of services that touch our MCAH population: –CPSP comparable services –Case management and coordination of care –Comprehensive medical coverage –Limited dental coverage –Initial health assessment –Mental health services –Immunizations, Family Planning, STD/HIV screening –Alcohol and substance abuse Tx –Health Education
Local Health Department Coordination Plans must have a subcontract or MOU with the following local agencies: –CCS –MCH –CHDP –WIC –Regional Centers
Local Health Department Coordination Plans must have a subcontract or MOU for public health services: –Family Planning –STD –HIV testing/counseling –Immunizations
Local Health Department Coordination Subcontract or MOU must include: –Scope and responsibilities of both parties in providing services to members –Billing and reimbursements –Reporting responsibilities –How services are coordinated between LHJ and the plan, including exchange of information.
Opportunities for LHJ Collaboration with MCMC Ask yourself: –Is there a mechanism to receive feedback from the community on the quality of perinatal services delivered through health plans? –Is the PSC (or designee) providing TA and education to plans regarding perinatal services and the plans responsibility for providing these services? –Is my LHJ providing any services that are the responsibility of the plans in my area? If so, is there a subcontract in place to outline reimbursement for the services my agency is providing?